Ann Clin Neurophysiol.  2019 Jul;21(2):71-78. 10.14253/acn.2019.21.2.71.

Transcranial Doppler: examination techniques and interpretation

• Do Y
• Kim YJ
• Lee JH

• KMID: 2454727
• DOI: http://doi.org/10.14253/acn.2019.21.2.71

Abstract

Transcranial Doppler (TCD) was introduced in 1982 to assess intracranial arteries noninvasively, since when it has been widely used to assess and monitor cerebrovascular hemodynamics. The clinical applications of TCD are broadening to include other fields that require monitoring of the cerebral blood flow. TCD has fewer temporal and spatial restrictions than other methods, can be performed on less-compliant patients, and causes no harm to the body. However, its reliance on high levels of examiner skill and experience, as well as a lack of standardized scanning protocols are obstacles that still need to be overcome. In this report we review TCD examination techniques and interpret their findings for several conditions.

Keyword

Transcranial Doppler; Standard examination; Interpretation

MeSH Terms

Arteries
Cerebrovascular Circulation
Hemodynamics
Humans

Figure

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  Fig. 1 The acoustic windows used in the head in routine transcranial Doppler: transtemporal (A), transorbital (B), suboccipital (C), and submandibular (D) windows. The patient consented to the use of these photographs.

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  Fig. 2 Blood-flow signal from the internal carotid artery bifurcation at a depth of approximately 65 mm. Toward- and away-flow signals are from the middle cerebral artery and the anterior cerebral artery, respectively. PI, pulsatility index; RI, resistance index; S/D, systolic diastolic ratio.

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  Fig. 3 Normal transcranial Doppler spectral waveform of the middle cerebral artery. The interval from phase 1 to phase 2 is referred to as systolic acceleration, and reflects the resistance from the heart to the artery of interest. The interval from phase 3 to phase 4 is the diastolic phase, and reflects the resistance from the artery of interest to the periphery. PI, pulsatility index; RI, resistance index; S/D, systolic diastolic ratio.

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  Fig. 4 Thrombolysis in Brain Ischemia grading system.

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  Fig. 5 A right-to-left shunt. One (A) and multiple (B) microembolic signals in the right middle cerebral artery are observed when performing the Valsalva maneuver. MCA, middle cerebral artery.

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  Fig. 6 The subclavian steal phenomenon. Bunny (A) and reversed (B) waveforms can be used to predict the presence of moderate stenosis (C) and occlusion (D) of the ipsilateral subclavian arteries, respectively.

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  Fig. 7 Waveforms in the middle cerebral artery of cerebral circulatory arrest. As the intracranial pressure and resistance increase, the end diastolic velocity decreases and finally the peak systolic velocity disappears.

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